COMMENTARY ON HEALTH AND VIOLENCE : Prevention Is Still Better, Less Costly Remedy for Nation’s Ills : To save lives and money, efforts must be made to decrease violent acts, tobacco use and substance abuse.

For doctors, health policy has taken on new dimensions in recent years as medical and social problems have become more inextricably linked. And with the development of a national health care program, there is increased attention being paid to the truism that prevention remains a better and less expensive remedy than a cure.

Hence, violence and substance abuse reduction, and the elimination of tobacco use were a major focus of the California Medical Assn. when the physician group recently met in Anaheim for its annual meeting.

Orange County doctors along with their colleagues throughout the state continue to witness an astounding increase in violence, including increased numbers of patients who are victims of violent acts and increased numbers of patients who are armed and threaten violence against hospital personnel.

In response, an anti-violence agenda was adopted by the CMA that includes: physician and patient education in violence prevention; increased efforts to reduce the violence portrayed in the media; establishment of a broad-based coalition of organizations to develop a comprehensive violence reduction program for California; adoption of a public health approach to violence prevention, and special efforts to recognize, identify and manage domestic violence victims.

In addition, the doctors voted to support legislation to enact the mandatory successful completion of a firearm use and safety course before purchasing, owning or using a firearm and ammunition in California.

Physicians in Orange County were gratified for the support doctors are giving the anti-violence campaign. For example, Dr. Peter Anderson, who heads emergency services at Fountain Valley Regional Hospital and Medical Center and sees the effects of violence in health care settings firsthand, believes that doctors and patients must be educated on the roles they must play in violence prevention to save money--and, most important, lives.

Among physicians, it is widely believed that the most significant statement of support for the anti-violence agenda may well be forthcoming with the nomination of a San Francisco physician, Dr. Phillip Lee, as assistant to the state secretary of health and human services. As a leading proponent of social medicine, he is expected to be a strong advocate for violence prevention.

The anti-violence campaign is relevant for Orange County and addresses problems for which few communities are exempt. Medical officials estimate injuries caused by violence add billions of dollars to health care costs each year. It is evident that we cannot afford either the financial--or the human--price of violence.

Statistics from the Research and Data Management Center of the county’s Health Care Agency reveal that in 1991, homicide was the leading cause of death for men between the ages of 15 and 24 in Orange County. It was the third leading cause of death among men between the ages of 25 to 34.

Last year the Orange County Human Relations Commission documented a record 188 hate-related incidents and crimes. The offenses included verbal slurs, severe beatings, stabbings and gunshot wounds. These assaults involved victims that include African-Americans, Asians, Latinos, whites, Arabs, Jews, Iranians and Muslims. The incidents occurred throughout the county. Many victims were treated and released from local hospitals where doctors believe that the reported numbers underrepresent the pervasive violence.

School violence is also on the rise in Orange County, and citizen groups are organizing and getting ready to fight back. This is the case in at least two cities, Anaheim and Irvine, according to Greg Smith, a member of the Irvine Unified School District board and the Safe Communities Task Force.

Last November, an act of gang violence involving students in Irvine spurred residents into action. Smith and other advocates of the local anti-violence campaign will work together to establish a network of organizations and agencies to develop joint public-private solutions to help reduce acts of violence in Orange County. It is important for communities to keep this vital issue at the forefront of discussion and action throughout the county.

Doctors also reaffirmed their commitment to an anti-tobacco campaign aimed at increasing the quality of life and controlling medical costs.

Physicians will continue to work toward a smoke-free environment that includes support through education on the harm caused by smoking and increased efforts to ban cigarette ads that target children.

They will also support legislative efforts to ban tobacco smoke from all work and public places and establish an excise tax of $3 on every pack of cigarettes. The cigarette tax money will specifically be spent to treat tobacco-related diseases, for research and for educational programs urging people to stop smoking.

While specific elements of national health reform are still being developed, we do know that all programs now being considered by the White House place added emphasis on increased personal responsibility for good health.

Physicians in Orange County and throughout the state are moving toward a violence- and smoke-free environment because they know that any meaningful health reform must include efforts to decrease violence, tobacco use and alcohol and substance abuse. These are essential elements of the public health imperatives of our time.